Conventional Laparoscopy versus Robotic-Assisted Aortic Lymph-Nodal Staging for Locally Advanced Cervical Cancer: A Systematic Review and Meta-Analysis

Abstract

Aortic lymph node metastases are a relative common finding in locally advanced cervical cancer. Minimally invasive surgery is the preferred approach to perform para-aortic lymph nodal staging to reduce complications, hospital stay, and the time to primary treatment. This meta-analysis (CRD42022335095) aimed to compare the surgical outcomes of the two most advanced approaches for the aortic staging procedure: conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RAL). The meta-analysis was conducted according to the PRISMA guideline. The search string included the following keywords: “Laparoscopy” (MeSH Unique ID: D010535), “Robotic Surgical Procedures” (MeSH Unique ID: D065287), “Lymph Node Excision” (MeSH Unique ID: D008197) and “Aorta” (MeSH Unique ID: D001011), and “Uterine Cervical Neoplasms” (MeSH Unique ID: D002583). A total of 1324 patients were included in the analysis. Overall, 1200 patients were included in the CL group and 124 patients in the RAL group. Estimated blood loss was significantly higher in CL compared with RAL (p = 0.02), whereas hospital stay was longer in RAL compared with CL (p = 0.02). We did not find significant difference for all the other parameters, including operative time, intra- and postoperative complication rate, and number of lymph nodes excised. Based on our data analysis, both CL and RAL are valid options for para-aortic staging lymphadenectomy in locally advanced cervical cancer.

Diagnosis of Cervical Cancer and Pre-Cancerous Lesions by Artificial Intelligence: A Systematic Review

“…The aim of this systematic review is to evaluate the diagnostic performance of AI technologies in cervical cancer and pre-cancerous lesions. Estimating the prognosis of cervical cancer is one of the most difficult tasks because its management requires a variety of cancer treatment approaches [ 162 , 163 ], which may even impair quality of life to a significant extent [ 164 , 165 ].…”

Save our surgeons (SOS) – an explorative comparison of surgeons’ muscular and cardiovascular demands, posture, perceived workload and discomfort during robotic vs. laparoscopic surgery

“…Robotic surgery has gained popularity and significance in MIS over the last few years and clinicians hope to further expand on the recognized advantages of the laparoscopic surgical technique for patients [ 7 ]. In this context, many scientific papers have reported on patient outcomes and surgical data when applying robotic surgery which has been summarized in recent systematic reviews [ 8 , 9 ]. In addition, it is presumed that robotic surgery provides ergonomic benefits for surgeons by reducing physical demands [ 10 ].…”

Progression Free Survival, Overall Survival, and Relapse Rate in Endometrioid Ovarian Cancer and Synchronous Endometrial-Ovarian Endometrioid Cancer (SEO-EC): Results from a Large Retrospective Analysis

“…Interestingly, we found higher rate of recurrence in the full staged patients (9.5% vs. 4.8%), despite it was not statistically significant. Systematic lymphadenectomy is indeed associated with high morbidity, even when performed by skilled surgeons [21,22] and, for this reason, the choice to perform this procedure should be carefully balanced and based on the available evidence. In this scenario, recent and promising data suggested that sentinel-node biopsy in early-stage ovarian cancer is feasible and has the potential to provide reliable and useful information on nodal status, and may allow the avoidance of systematic lymphadenectomy in the majority of patients [23,24].…”